Bush’s Mental Illness Screening Squad On the Move
First published July 14, 2006
The tax dollar funded mental health screening programs popping up in every corner of the nation represent an enormous gift to Big Pharma from the Bush administration. After all, drug companies can’t push drugs without a lucrative customer base, so the screening programs are a great solution for that little problem.
On April 29, 2002, Bush kicked off the whole mental health screening scheme when he announced the establishment of the New Freedom Commission (NFC) during a speech in in New Mexico where he told the audience that mental health centers and hospitals, homeless shelters, and the justice and school systems, have contact with individuals suffering from mental disorders but that too many Americans are falling through the cracks, and so he created the NFC to ensure “that the cracks are closed.”
In words relevant here, the late President Ronald Reagan aptly described government intervention this way: “The nine most terrifying words in the English language are, “I’m from the government and I’m here to help.”
According to award-winning investigative reporter, Kelly O’Meara: “Nowhere is this quote more appropriate than when applied to George W. Bush’s New Freedom Commission on Mental Heath.”
A little over a year after Bush announced the formation of the NFC, on July 22, 2003, government report was released that called for redesigning the mental health systems in all 50 states. A press release previewing the report stated:
“Achieving this goal will require greater engagement and education of first line health care providers—primary care practitioners—and a greater focus on mental health care in institutions such as schools, child welfare programs, and the criminal and juvenile justice systems. The goal is integrated care that can screen, identify, and respond to problems early.”
About 7 months later, on February 5, 2003, a subcommittee report was released titled, “Promoting, Preserving and Restoring Children’s Mental Heath,” and stated in part:
“The extent, severity, and far-reaching consequences of mental health problems in children and adolescents make it imperative that our nation adopt a comprehensive, systematic, public health approach to improving the mental health status of children.”
The NFC’s final report calls for screening every child in America, including preschoolers, and points our that, “schools are in a key position to identify mental health problems early and to provide a link to appropriate services.”
In addition, according to the final report, every child plugged into a government program, will automatically be screened in accordance with the following recommendation:
“Screening should be implemented upon entry into, and periodically thereafter in, the juvenile justice and child welfare systems, as well as in other settings and populations with known high risk, such as the Medicaid population.”
“When mental health problems are identified,” the report says, “youth should be linked with appropriate services and supports.”
Critics say “appropriate services and supports” means doctor’s prescribing drugs. According to the results of a 2002 survey of recently trained child psychiatrists, in the Journal of American Academy of Child Adolescent Psychiatry, nine out of 10 pediatric patients under their care were treated with prescription drugs.
The NFC specifically calls for all screening programs to be linked to “state-of-the-art treatments” using “specific medications for specific conditions.”
The Texas Medication Algorithm Project (TMAP) is the centerpiece of the NFC’s recommendation for “specific medications.” Algorithms are lists of drugs with guidelines that medical professionals must follow when prescribing medication to patients for specific mental illnesses, and contain flow charts that illustrate step-by-step prescribing process.
The TMAP drug lists and guidelines were developed and approved in Texas while Bush was Governor, through an “expert opinion consensus” by a panel of medical professionals chosen by the pharmaceutical sponsors of the program that included Janssen Pharmaceutica, Eli Lilly, Johnson & Johnson, Astrazeneca, Pfizer, Novartis, Janssen-Ortho-McNeil, GlaxoSmithKline, Abbott, Bristol Myers Squibb, Wyeth-Ayerst and Forrest Laboratories.
Critics say TMAP is a marketing scheme thought up by Big Pharma after a slew of new psychiatric drugs were approved for sale in the 1990’s, and drug companies realized that there was no way to advertise and promote psychiatric drugs to recruit customers.
Once approved, TMAP guaranteed an avalanche of sales for Big Pharma in Texas, because medical professionals were required to follow the TMAP guidelines with all patients in state institutions, such as mental hospitals and prisons, and when prescribing drugs to children in foster care or juvenile justice programs, and for all patients covered by government funded health care programs.
The NFC recommends TMAP as the model program for “specific medications” to be used in all 50 states. The “specific medications” are the most expensive drugs on the market and include drugs known as selective serotonin reuptake inhibitors antidepressants (SSRIs), like Paxil, Prozac, Zoloft, and Effexor, and the atypical antipsychotics, that include Zyprexa, Risperdal, Geodon, Seroquel, Clozaril, and Abilify.
Other “specific medications” include the ADHD drugs, fondly known as “speed” to street addicts, such as Adderall, Dexedrine, Concerta, Ritalin and Strattera, and a garden variety of “downers,” like Valium, Xanax, Librium and sleeping pills.
Critics have constantly attacked Big Pharma’s involvement in choosing the drugs on the lists. As far back as January 1999, Peter Weiden MD, one of the “experts” on the original Texas panel, openly criticized the approval process in the Journal of Practice in Psychiatry and Behavioural Health, because so drug company money was involved.
For instance, he said, the guidelines for the atypical antipsychotics were funded by Janssen, the maker of Risperdal, and most of the guidelines’ authors also had received financial support of one kind or another from the drug companies with atypical drugs on the list. “This potential conflict of interest may create credibility problems,” he wrote, “especially concerning any recommendations supporting the use of atypical antipsychotics.”
The way the NFC scheme is set up, tax dollars not only fund the implementation of the screening programs, but also a large portion of the costs for “specific medications” that are prescribed to patients to treat mental disorders detected by the screenings through government health care programs like Medicaid.
The fact is, when Bush took office, he owed Big Pharma a lot of favors in return for all the money he raked in from the industry and the mental health screening scheme represents a major part of his efforts to cover those debts.
The financial backing that Bush received from Big Pharma is legend and its safe to say that he would not be sitting in the White House today without it.
In 2004, a report by the advocacy group, Public Citizen, listed 21 drug industry and HMO executives or lobbyists among Bush’s Rangers and Pioneers – titles given only to those people who have raised at least $200,000 or $100,000, respectively, for one of his presidential campaigns.
The list includes 5 executives from drug companies, 6 officials from HMOs, the CEO of a pharmacy services company, the head of a direct-mail pharmacy, and 8 lobbyists who represent drug companies and HMOs at the time.
Eli Lilly, a manufacturer of many of the “specific medications” chosen for the lists, has multiple ties to the Bush family dating back decades. Before becoming President Reagan’s Vice President, the first President Bush was a member of Lilly’s board of directors and the current President Bush appointed Lilly CEO, Sidney Taurel, to the Homeland Security Council.
In the year 2000, eighty-two percent of Lilly’s $1.6 million in political contributions went to Bush and the Republican Party.
Another industry big-wig, retired Bristol-Myers Squibb Vice-Chairman, Bruce Gelb, was a Bush Pioneer who also had longstanding ties to the Bush family. Gelb was appointed chief of the US Information Agency, and ambassador to Belgium, by the first President Bush.
Before the 2000 election, Bristol-Myers executives reportedly were pressured to make maximum donations to the Bush campaign and reluctant donors were warned that CEO, Charles Heimbold Jr, whom Bush later named ambassador to Sweden, would be informed if they failed to give, according a September 5, 2003 New York Times article.
Pfizer CEO, Hank McKinnell, was a 2004 Bush Ranger and until 2003, served as chairman of the board of Pharmaceutical Research & Manufacturers of America, the industry’s gigantic trade group, until Republican lawmaker, Billy Tauzin, quit Congress and took over the position that came with a multi-million dollar package in combined salary and perks.
Although all of the TMPA medications are only approved by the FDA for treatment of a limited number of mental illnesses like schizophrenia or major depressive disorder or bipolar disorder, in specific age groups, and with specific dosages, drug makers have doctors prescribing the medications off-label for unapproved uses to persons of all ages for just about any ache and pain, and especially with patients being screened for mental illness by the government backed programs.
To accomplish this mass screening of the nation’s 52 million school children, the NFC recommends that the TeenScreen program, billed as a suicide prevention survey, be set up in public school system nationwide. In May 2004, Illinois passed a resolution approving the implementation of TeenScreen in all public schools in that state.
TeenScreen is also an invention of Big Pharma developed and promoted through back door funneling of money through front groups that bill themselves as advocates for the mentally ill and promoting suicide prevention.
By far, TeenScreen has become the most controversial of all screening programs, and critics are quick to point out a number of reasons. According to the June 16, 2006, Washington Post, there were only 1,737 suicides by children and adolescents in the US during 2003, the last year for which national statistics are available.
According to the Department of Health and Human Services, in 2003, for every 100,000 children the rate of suicide for boys was 11.6 and the rate for girls was 2.7, which amounts to less than 2 boys in every 10,000 kids, and the number of suicides by girls in every 10,000 children, is too low to even calculate.
In perhaps one of their best arguments against TeenScreen, critics are asking how such a low suicide rate, when measured against the total student population, can possibly justify subjecting 52 million children to mental health screening and the distinct probability that a high number of children will end up on psychiatric drugs with side effects that cause many more deaths each year than the number of child suicides.
In fact, overall, the statistics for people injured or killed each year due to prescription medications are extremely high. According to a study published by Adverse Drug Reactions, more than 1.5 million people are hospitalized each year and more than 100,000 die from largely preventable adverse reactions to drugs that should not have been prescribed in the first place.
Advocacy groups against TeenScreen have posted a petition online with plans to send it to state and federal lawmakers. Persons interested in signing the petition can click on the following link: http://www.petitiononline.com/TScreen/petition.html
In 2004, Illinois became the first state to implement mental health screening programs. Its plan calls for both children and adults to be screened during their routine physical exams. To that end, the state legislature passed the Illinois Children’s Mental Health Act (ICMHP), which is expected to become a model for other states.
The final report by the ICMHP Task Force calls for a comprehensive, coordinated children’s mental health system comprised of prevention, early intervention, and treatment for children ages 0-18, along with a statewide data-reporting system to track information on each person.
It requires social-emotional development screens with all mandated school exams (K, 4th, and 9th), and says to: “Start early, beginning prenatally and at birth, and continue throughout adolescence, including efforts to support adolescents in making the transition to young adulthood,” and includes a plan to screen all pregnant women
Critics of the Illinois plan say they are especially curious about what might be in store for the infants screened prenatally and at birth, at the ripe old age of 0.
The Illinois task force stressed the need to (1) improve Medicaid reimbursement for prevention, intervention and treatment services; (2) recognize diagnoses for young children described in DC:0-3 and pay for mental health services for children with any of these diagnoses; and (3) clarify for providers the diagnoses that create eligibility for children to obtain Medicaid services.
According to former medical services billing analyst, Chris Kelly, in plain language, this means to make sure and have doctors diagnosis patients with specifically coded mental illnesses for which Medicaid will pay the costs of the prescription drugs for treatment.
And studies reveal that talk therapy is a thing of the past because pushing pills is by far more profitable. A 2003 study by the American Psychiatric Association, on “financial disincentives” for psychotherapy, found doctors could earn about $263 an hour for doing three 15-minute “medication management” sessions, verses about $156 for a single 45- to 50-minute therapy session. Thus, conducting therapy verses medication management would represents an hourly pay cut of 41%, the APA study said.
On August 17, 2005, the Wall Street Journal quoted, Juan Riestra, associate director of medicine in the department of psychiatry at Mountainside Hospital in Montclair, NJ, as saying a psychopharmacologist is often someone “using a trendy word as a marketing device.”
When a psychopharmacologist sees 30 or 40 patients a day, as some do, Mr Riestra told the Journal, “it becomes like a factory.”
One of the more recent screening programs that has caught the attention of anti-drugging activists, is a survey called “Signs of Suicide” (SOS), which is being touted as a self-assessment screening tool and is provided free online on the internet.
This particular psychiatric screening program claims it is being promoted as an effort to reduce suicides, alcoholism, depression and eating disorders, to be used in high schools, colleges, the workplace, and the military.
SOS comes highly recommended by the Bush administration for members of the military and their families. As of May 26, 2006, Air Force Colonel Joyce Adkins, a psychologist at the Pentagon’s Health Affairs office, claims that several thousand military people have been screened with the program since it went online around the beginning of 2006.
According to the May 26, 2006, Boston Globe, if the responses to the screening indicate possible trouble, SOS suggests options for seeking help.
Obtaining a diagnosis of mental illness could not get any easier than with SOS. This online survey, “is always available,” Ms Adkins told the Boston Globe on May 26, 2007. “You don’t have to go anywhere,” she said. “You don’t have to have child care or change your clothes.”
SOS claims it is the creation of the “nonprofit” Massachusetts-based corporation, Screening for Mental Health, Inc (SMH). However, as it turns out, the development of the firm’s screening programs, was funded with millions of dollars from Big Pharma.
A picture taken at the company during an event in honor of, “National Depression Screening Day,” (whatever that is), on October 18, 2001, shows Eli Lilly presenting SMH with a check for $500,000.
But Lilly’s half-million dollar grant was just the tip of the iceberg. SMH has also received millions of dollars in grants from other drug giants including Pfizer, Solvay, Abbott Labs, Wyeth, Forest Pharmaceuticals, the Robert Johnson Foundation, AstaZeneca and GlaxoSmithKline.
Kevin Hall, New England director of the Citizens Commission on Human Rights, has been investigating mental health screening programs for a number of years, and was able to obtain the SMH’s tax returns that reveal just how much money has been funneled to the company to develop and promote the mental health screening programs since 2001.
All total, the tax records show that Lilly poured $2,157,925 into SMH between 2001 and 2004, and for the year 2004 alone, in addition to Lilly’s $600,000, Pfizer gave SMH $125,000, Wyeth ponied up $100,000, and Forest Labs gave $153,000
These “free” online mental health screening programs are also being promoted in colleges all across the country. Brian Hokanson is a college student in Minnesota who wrote a commentary describing his experience with an online survey.
At the beginning of last fall’s semester, Brian noticed fliers in his residence hall that were encouraging students to take a free online screening test for depression.
Brian says he soon found out that any combination of answers on the screening resulted in a recommendation to see a doctor. The first section of the test, he says, listed negative behaviors such as “feeling bad about yourself” and “feeling tired or having little energy.”
For each statement checked, Brian was instructed to chose how often the statement applied to him in the previous two weeks, ranging from “not at all” to “nearly every day.”
In the second part of the test, the student is asked to rate how difficult each of the behaviors checked has made it to function in daily life, ranging from “not difficult at all” to “extremely difficult.”
Brian says he decided to “test the test,” and chose “not at all” for all of the behaviors except for “poor appetite or overeating,” and he said that statement applied to him for “several days.” On the second section, he stated that the problem made it “not difficult at all” for him to function in daily life.
Upon clicking on the results, Brian was told: “Your screening results are consistent with minimal depression … You are advised to see your doctor or a mental health professional for a complete evaluation as soon as possible.”
As for the inventor of this particular screening tool, Brian reports that the fine print at the bottom of the page of the survey reads: “Copyright 1999 Pfizer, Inc.”
The good news is, that after “testing the test,” things did not go according to plans because Brian did not become a new SSRI customer for Pfizer, which means he won’t be experiencing any horrific side effects from SSRI use.
The NFC also recommends screening for all pregnant women that will predictably lead to the use of SSRIs, even though a study as far back as the February 2, 2004, American Journal of Pediatrics, said that pregnant women who use SSRIs “to combat depression could be damaging the brains of their unborn babies.”
At the other end of the life-cycle, the mental health screening squad is swarming in on the nation’s 36 million senior citizens, who already represent a gold mine to Big Pharma because they use so many medications. The screening program for the elderly is set up through the, “Positive Aging Act of 2005.”
The Act provides federal tax dollars for community-based mental health treatment outreach teams and states: (a) In General- The Secretary … shall award grants to public or private nonprofit entities that are community-based providers of geriatric mental health services, to support the establishment and maintenance by such entities of multi-disciplinary geriatric mental health outreach teams in community settings where older adults reside or receive social services.
The Act wants outreach teams to:
(1) adopt and implement … evidence-based intervention and treatment protocols (to the extent such protocols are available) for mental disorders prevalent in older individuals (including, but not limited to, mood and anxiety disorders, dementias of all kinds, psychotic disorders, and substance and alcohol abuse), …
(2) provide screening for mental disorders, diagnostic services, referrals for treatment, and case management and coordination through such teams; and
This plan seeks to round up seniors for screening wherever they can be found, including (1) senior centers; (2) adult day care programs; and (3) assisted living facilities.
A new recruitment scheme for senior citizens was totally unnecessary because Big Pharma has been over-medicating these customers for years. Recent research reveals that nursing home residents in particular are being drugged in record numbers.
In October 2005, the Journal of the American Medical Association, published a meta-analysis of 15 randomized trials of more than 5,000 elderly patients treated with atypicals that found patients taking the drugs had a 54% increased chance of dying within 3 months, compared with patients taking a placebo.
Another Big Pharma money-making tactic is to promote the off-label prescribing of drugs at a higher dose than necessary which, experts say, is extremely dangerous with older people because their bodies cannot not metabolize or excrete drugs as rapidly as younger patients.
In a study published in the June 13, 2005, Archives of Internal Medicine, that examined the quality of antipsychotic prescriptions for nearly 2.5 million Medicaid patients in nursing homes, “over half (58.2%),” received antipsychotics that exceeded the maximum recommended dosage or received duplicate therapy or had inappropriate indications for the drugs to begin with.
The study found that more than 200,000 nursing home residents received antipsychotic therapy with “no appropriate indications for use.”
As a result of concealing negative information about these psychiatric drugs and the promotional tactics by the drug makers of encouraging the off-label prescribing of the medications for so many different uses, experts say, tens of millions of people are now taking the medications without any valid indication for their use.
In fact, so many people are being prescribed these expensive drugs that the TMAP part of the marketing scheme is coming apart at the seams due to pure and simple greed. State lawmakers say that the costs incurred due to the over-prescribing of the drugs are bankrupting state Medicaid programs and they have to stop the practice of over-prescribing to keep from going broke.
According to the July 27, 2005, Wall Street Journal, antidepressants and antipsychotics are the third and fourth biggest classes of drugs in the US after cholesterol and heartburn medicines, with sales of $20.7 billion in 2004, with much “of that cost is borne by government health-care plans,” the journal said.
The prices per pill for these drugs are themselves insane. For example, in South Carolina, Zyprexa is the most expensive atypical covered by Medicaid, and according to James Assey, a pharmacist with the South Carolina Department of Health and Human Services, a one-month supply pills costs Medicaid over $700.
The state of Georgia totally removed Zyprexa from its preferred drug list and any doctor who wants to start a Medicaid patient on Zyprexa, must now submit a clinical rationale stating why it’s the only drug appropriate, according to the November 28, 2005, Indianapolis Business Journal.
Other states, including Tennessee, Illinois, Louisiana, and Pennsylvania also now require doctors to obtain prior authorization before prescribing Zyprexa to Medicaid patients, the Journal reports.
Big Pharma is making a ton of money off selling these drugs off-label for kids. A report in the April 24, 2005, Columbus Dispatch, found that 40,000 children aged 6-18 who were covered by Medicaid were prescribed psychotropic drugs: 31% of the children were in foster care, and 22% were in juvenile detention. Medicaid spent $65.5 million for drugs used primarily as “chemical restraints,” according to Pyle, P, “Drugged into Submission.”